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Starr Indemnity & Liability Company Dallas, Texas Administrative Office: 399 Park Avenue, 8th Floor, New York, NY 10022 Excess Liability Policy Named Insured: IPHFHA Risk Purchasing Group Policy Number: 1000035092151 Effective Date: July 1, 2015 at 12:01 A.M. This Policy is a legal contract between the Named Insured an... | 2 |
WORKERS COMPENSATION CLASSIFICATION SCHEDULE Insurance for this coverage part provided by: ZURICH AMERICAN INSURANCE COMPANY Policy Number WC 4459925-00 ITEM 4. CLASSIFICATION OF OPERATIONS PREMIUM BASIS RATES Entry in this item, except as specifically provided elsewhere in this Total Estimated Estimated LOC. policy, d... | 1 |
Will Liberty Mutual Update This Privacy Notice? We reserve the right to makes changes to this notice at any time and for any reason. The updated version of this policy will be effective once it is accessible. You are responsible for reviewing this policy to stay informed of any changes or updates. Who Do I Contact Rega... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 19 PREMIUM DUE DATE ENDORSEMENT This endorsement is used to amend: Section D. of Part Five of the policy is replaced by this provision. PART FIVE PREMIUM D. Premium is amended to read: You will pay all premium when due. You will pay the premium even... | 2 |
Policy Number AS2-641-433446-140 GARAGEKEEPERS SCHEDULE Applicable to: CA 01 94 10 13, CA 99 37 10 13, CA 99 71 10 11 Location Number Address Where You Conduct Garage Operations 28 1403 North Bluff, Fulton, MO 65251 Coverages Limit Of Insurance And Deductible Premium Comprehensive $60,000 Limit Of Insurance INCL $500 D... | 2 |
Policy Number AI2-291-544944-054 ITEM FOUR - Schedule of Hired or Borrowed Covered Auto Coverage and Premiums (continued) Physical Damage Coverages - Cost of Hire Rating Basis for All Autos (Other than Mobile or Farm Equipment) Rate per Estimated Each $100 Minimum Annual Annual Cost Coverage State Limit of Insurance Pr... | 2 |
ace usa LEAD SHEET FOR: LOCKTON COMPANIES LLC RUN DATE: 08/29/2016 POLICY NUMBER: XSL G27855702 ID: Z02COLS1 RUN BY: ACEINAISTCOLE PAGES OF THIS COPY: 0148 INSURED'S NAME Werner Enterprises, Inc. | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 14 A (Ed. 1-19) POLICY NUMBER: 41WCI1655601 90-DAY REPORTING REQUIREMENT-NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT You must report any change in ownership to us in writing within 90 days of the date of the change. Change in ownership includes ... | 2 |
ITEM TWO LIMITS OF INSURANCE EACH OCCURRENCE LIMIT $ 1,000,000 DAMAGE TO PREMISES RENTED TO YOU LIMIT $ 1,000,000 Any one premises MEDICAL EXPENSE LIMIT $ N/A Any one person PERSONAL & ADVERTISING INJURY LIMIT $ 1,000,000 Any one person or organization GENERAL AGGREGATE LIMIT $ 2,000,000 PRODUCTS/COMPLETED OPERATIONS A... | 2 |
LIMITS OF INSURANCE EACH OCCURRENCE LIMIT $2,000,000 DAMAGE TO PREMISES RENTED TO YOU LIMIT $200,000 Any one premise MEDICAL EXPENSE LIMIT $15,000 Any one person PERSONAL & ADVERTISING INJURY LIMIT $2,000,000 Any one person or organization GENERAL AGGREGATE LIMIT $4,000,000 PRODUCTS/COMPLETE OPERATIONS AGGREGATE LIMIT ... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 39 B (Ed. 02-18) ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE Designated Operation(s) Coverage The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this p... | 2 |
b. If the policy has been extended for 90 days e. If the first Named Insured requests a or less, provided that notice has been given change in the terms or conditions or risks in accordance with Paragraph C. 1. covered by the policy within 60 days of the C. If you have obtained replacement coverage, end of the policy p... | 2 |
NATIONAL COMMON POLICY DECLARATIONS INTERSTATE Policy Number Policy Period From To NATIONAL INTERSTATE INS. CO. VEX 4900062 01 03/01/2014 03/01/2015 3250 INTERSTATE DR. 12:01 A.M. Standard Time at the described location RICHFIELD, OH 44286-9000 Previous Policy Number Customer Number ITEM ONE: VEX 4900062 4900000062 Tra... | 2 |
Associated Industries Insurance Company, Inc. Policy Number: A Administered through: AmTrust E & S Insurance Services, AES1028578 07 Inc. Named Insured: AmTrust E&S Insurance Services 200 State Street, 4th Floor West Coast Reinforcing, Inc An AmTrust Financial Company Boston, MA 02109 COMMERCIAL GENERAL LIABILITY EXTEN... | 1 |
Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number B. PIETRINI & SONS 111 EAST CHRUCH ROAD Policy Number KING OF PRUSSIA PA 19406 Symbol: RWC Number: C58582633 Policy Period Effective Date of Endorsement 05-05-2020 TO 12-01-2020 05-05-2020 Issued By (Name of Insurance Company) ACE AM... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 00 11 Edition 1/08 EXTENSION OF INFORMATION PAGE Name and Address of Insured: Policy No.: RWR943531802 POCH STAFFING, INC. DBA TRILLIUM STAFFING SOLUTIONS AND SUBSIDIARIES 1499 REGAL ROW, SUITE 304 Policy Period: DALLAS, TX 75247 July 1, 2013 to July 1... | 1 |
DISCLOSURE OF PREMIUM AND ESTIMATED PREMIUM FOR CERTIFIED ACTS OF TERRORISM COVERAGE (PURSUANT TO TERRORISM RISK INSURANCE ACT) Named Insured Endorsement Number Parsons Brinckerhoff Group Inc. Policy Symbol Policy Number Policy Period Effective Date of Endorsement HXW G24096348 006 10/01/2014 to 10/01/2015 10/01/2014 I... | 2 |
IL 02 68 01 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NEW YORK CHANGES S-CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE... | 2 |
STARR Workers Compensation and Employers Liability Insurance Policy Policy Number: 100 0004019 INDEMNITY Named Insured: MEDSPEED, LLC A MEMBER OF STARR COMPANIES Agent: CLAUDIA MANDATO 0502726 ENDORSEMENT SCHEDULE State Form Nbr. Ed. Date Description CA WC000115 1/20 NT EN PNDG LAW CHG TRIPRA 2015 CA WC000301A 2/89 ALT... | 0 |
POLICY NUMBER: (13) 7354-66-97 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respe... | 2 |
Starr Surplus Lines Insurance Company Chicago, IL 1-646-227-6300 Missouri Changes - Pollution Exclusion Policy Number: 1000010467 Effective Date: 04/01/2014 at 12:01 A.M. Named Insured: Quaker Window Products Co. SECTION V. EXCLUSIONS, exclusion D. Pollution is amended to include the following: This pollution exclusion... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Liberty Mutual. INSURANCE INFORMATION PAGE 175 Berkeley Street Boston, MA 02116 Issued by Liberty Insurance Corporation (a stock company) 21814 Policy Number WC7-641-037305-013 Issuing Office Lewiston, ME Renewal Of WC7-641-037305-012 Issue Date 08/06/2013 A... | 2 |
CHUBB® Name & Mailing Address of the Insured Attached to and Forming Part of NORTHGATEARINSO, INC. Policy Number (17)7174-92-15 8880 FREEDOM COMMERCE PKWY JACKSONVILLE FL 32256 Policy Period 12/01/16 to 12/01/17 FEIN 651205969 NJTIN: 651205969000 Effective Date 12/01/16 Name & Address of the Producer LOCKTON COMPANIES,... | 2 |
ZURICH COMMERCIAL INSURANCE COMMON POLICY DECLARATIONS Policy Number BAP 3707384-13 Renewal of Number BAP 3707384-12 Named Insured and Mailing Address Producer and Mailing Address D.C. TAYLOR CO. LOCKTON COMPANIES, LLC (SEE NAMED INSURED ENDT) 1015 N 98TH ST STE 101 312 29TH ST., NE OMAHA NE 68114-2357 P.O. BOX 97 CEDA... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY - INFORMATION PAGE Servicing Office: Insurance for this coverage part provided by: SCHAUMBURG ZURICH AMERICAN INSURANCE COMPANY 1299 ZURICH WAY SCHAUMBURG, IL 60196 1. Policy Number WC 9928637-00 Renewal of Number NEW Named Insured and Mailing Address Produc... | 2 |
IL 02 66 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UTAH CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART C... | 2 |
Page 6 of 9 EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC 024-78-0994 TENNESSEE 917019479 Policy Prefix & No. Schedule INTRA/Independent State Risk ID 055-09-1016-10 EXPRESS SERVICES, INC. Item 4. Classification of Operations Premium Basis Rates Code Estimated Total Per $100 of Estimated No. Annual Remuneration Remun... | 1 |
CHUBB Commercial Umbrella Liability Coverage Form Declarations IL0985 0115 DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT IL0141 0908 NEW JERSEY CHANGES - CIVIL UNION IL0208 0907 NEW JERSEY CHANGES - CANCELLATION AND NONRENEWAL XS-45423b (11/17) Page 5 of 5 | 0 |
IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PHYSICAL DAMAGE DEDUCTIBLES This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM ITEM TWO of the Declarations is amended to include the fol... | 2 |
SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: TWIN CITY FIRE INSURANCE COMPANY Company Code: 7 Policy Number: 37 WB BN3284 Schedule Number: 01-19-01 Effective Date: 10/01/13 Effective hour is t... | 1 |
The First Liberty Insurance Corporation Item 3. Coverage D - Extension of Information Page Miscellaneous Form and Endorsement Schedule Continued: Policy Endorsements Form Number Comments Form Name WC 40 06 01 A South Dakota Direct Action Statute WC 40 06 02 South Dakota Benefits Deductible WC 40 06 03 South Dakota Mana... | 0 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY - INFORMATION PAGE Servicing Office: Insurance for this coverage part provided by: SCHAUMBURG ZURICH AMERICAN INSURANCE COMPANY 1299 ZURICH WAY SCHAUMBURG, IL 60196 1. Policy Number WC 0756367-00 Renewal of Number NEW Named Insured and Mailing Address Produc... | 2 |
Endorsement No.: 5 Form: CXU 607 0509 Rev. Page: 1 Effective Date: December 01, 2020 Issue Date: Attached to and forming part of Policy No.: US00011830LI20A Issued To: Burns & McDonnell, Inc. By: XL Insurance America, Inc. Crisis Loss, Cost and Expense Exclusion This endorsement changes the policy. Please read it caref... | 2 |
Liberty Mutual Fire Insurance Company Item 3. Coverage D - Extension of Information Page Miscellaneous Form and Endorsement Schedule Continued: Policy Endorsements Comments Form Number Form Name WC 00 04 22 C Terrorism Risk Insurance Program Reauthorization Act Disclosure WC 00 04 25 Experience Rating Modification Fact... | 0 |
DECLARATIONS EXTENSION SCHEDULE (continued) Policy Number TBC-Z91-469603-010 Class Code Premium Basis Rates Premium 47367 Payroll Per 1000 Products/Completed Operations included Premises/Operations if any 4.225 Total for NEVADA NEW HAMPSHIRE Unspecified Location 47367 Payroll Per 1000 Products/Completed Operations incl... | 1 |
Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number UNION COUNTY CONSTRUCTION GROUP, INC. 638 CHERRY STREET Policy Number GLOUCESTER CITY NJ 08030 Symbol: RWC Number: C58582542 Policy Period Effective Date of Endorsement 04-29-2020 TO 12-01-2020 04-29-2020 Issued By (Name of Insurance... | 2 |
DECLARATIONS EXTENSION SCHEDULE (continued) Policy Number TBC-Z91-469603-010 Class Code Premium Basis Rates Premium 47367 Payroll Per 1000 Products/Completed Operations included Premises/Operations 1,350 2.899 $4 Total for WISCONSIN $4 WYOMING Unspecified Location 47367 Payroll Per 1000 Products/Completed Operations in... | 1 |
IMPORTANT NOTICE TO POLICYHOLDERS - ADDITION OF TERRORISM COVERAGE This renewal policy contains certain modifications of coverage. Compared to your present policy, your renewal may be broader in some areas and more restrictive in others. The brief statements below highlight some of these changes. NO COVERAGE IS PROVIDE... | 2 |
ISSUED BY THE STOCK INSURANCE COMPANY HEREIN CALLED THE COMPANY AGENT NUMBER POLICY NUMBER GRANITE STATE INSURANCE COMPANY 0036877-00 WC 000-99-9380 13102 013-52-0814-40 INCORPORATED UNDER THE LAWS OF PENNSYLVANIA ITEM 1 NAMED INSURED: MAILING ADDRESS IDENTIFICATION NO.: SPEC CON, LLC AIG 1511 BALTIMORE, STE. 600 KANSA... | 2 |
SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD CASUALTY INSURANCE COMPANY Company Code: 3 Policy Number: 37 WB BX6927 Schedule Number: 29-37-01 Effective Date: 08/01/14 Effective hour i... | 1 |
Item 4. Premium - Extension of Information Page Classification of Operations Premium Basis Rate Entries in this item, except as specifically provided Payroll Unless Payroll- elsewhere in this policy, do not modify any of the other otherwise indicated provisions of this policy. Class a) Flat Charge Per $100 Estimated Co... | 1 |
Chubb Group of Insu ce Companies INFORMAT I PAGE WORKERS COMPENSATION AND 15 Mountain View Road, Warren, NJ 07060 EMPLOYERS LIABILITY POLICY CHUBB Item 1. Name & Mailing Address of the Insured Issued by CHUBB INDEMNITY INSURANCE COMPANY TORTOISE CAPITAL ADVISORS, LLC a stock insurance company 11550 ASH ST, STE 300 inco... | 2 |
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE OF FORMS AND ENDORSEMENTS Named Insured The Gerson Company Policy Number Policy Period GLH-900601-0516 From 05/26/2015 To 05/26/2016 Forms and Endorsements CAAP423 0814 Composite Rate and Basis of Premium ABGL600 0212 Asbestos Exclusion ABGL605 021... | 0 |
AAIS This endorsement changes CU 0702 09 10 the policy Page 1 of 1 PLEASE READ THIS CAREFULLY -- EXCLUSION -- FUNGUS OR RELATED PERILS COVERAGES E AND U The Commercial Excess/Umbrella Liability a. actual or alleged "bodily injury", "property Coverage is amended as follows. All other damage", or "personal and advertisin... | 2 |
Policy Number 41GPP1010201 COMMON POLICY DECLARATIONS ARCH INSURANCE COMPANY Named Insured HNI CORPORATION Effective Date: 07-01-19 12:01 A.M., Standard Time Agent Name LOCKTON COMPANIES, LLC Agent No. 00272 Item 1. Named Insured and Mailing Address Agent Name and Address HNI CORPORATION LOCKTON COMPANIES, LLC 600 EAST... | 2 |
Policy Number ASC-Z91-434710-035 ITEM TWO - Schedule of Coverages and Covered Autos This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular cove... | 2 |
Z ZURICH COMMERCIAL INSURANCE COMMON POLICY DECLARATIONS Policy Number BAP 0176782-00 Renewal of Number NEW Named Insured and Mailing Address Producer and Mailing Address AMERICAN CONTRACTING, LLC LOCKTON COMPANIES, LLC 141 M ST 1015 N 98TH ST STE 101 LINCOLN NE 68508-2436 OMAHA NE 68114-2357 Producer Code 28832-000 Po... | 2 |
Item 4. Premium - Extension of Information Page Classification of Operations Premium Basis Rate Entries in this item, except as specifically provided Payroll Unless Payroll- elsewhere in this policy, do not modify any of the other otherwise indicated provisions of this policy. Class a) Flat Charge Per $100 Estimated Co... | 1 |
Coverage Is Provided In: Liberty Policy Number: Ohio Security Insurance Company BLS (20) 58 64 76 86 Mutuál. Policy Period: INSURANCE From 03/05/2019 To 03/05/2020 12:01 am Standard Time Commercial General Liability at Insured Mailing Location Declarations Schedule Named Insured Agent ELEVATION HEATING AND A/C (855) 89... | 1 |
WC 00 04 22 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) POLICY NUMBER: 41WCI1655601 e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81% of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000, w... | 2 |
B. Rejection Of Stacked Underinsured Motorist Protection If you have elected to purchase Underinsured Motorists Coverage, you have the option to reject stacked Underinsured Motorists Coverage for a reduced premium. You may reject stacked Underinsured Motorists Coverage by signing the waiver below. By signing this waive... | 2 |
Item 4. Premium - Extension of Information Page Classification of Operations Premium Basis Rate Entries in this item, except as specifically provided Payroll Unless Payroll- elsewhere in this policy, do not modify any of the other otherwise indicated provisions of this policy. Class a) Flat Charge Per $100 Estimated Co... | 1 |
Policy Number (15)7358-90-43 SCHEDULE OF FORMS AND ENDORSEMENTS Named Insured LES PRODUI TS FRACO LTEE Effective Date: 05-30-2015 12:01 A.M., Standard Time Agent Name LOCKTON COMPANI ES/ GAB Agent No. 18943-000 COMMON POLI CY FORMS AND ENDORSEMENTS 16-10-0116 03-05 DEAR POLI CYHOLDER MCCA 6-10-0254 02-04 ADVI SORY NOTI... | 0 |
Date: 03/20/2015 Policy Number: 396-25-60 Underwriter Name: FEDA MORRISSEY Underwriter Region: 0002 Underwriter Branch: 0002 Underwriter Telephone: 312-930-5300 Operator Name: Christopher Fisher Operator Telephone: Issuing Division: 0073 Policy Effective Date: 04/01/2015 Transaction Type: NB Set Copy Name: ELECTRONIC C... | 2 |
Item 4. Premium - Extension of Information Page Classification of Operations Premium Basis Rate Entries in this item, except as specifically provided Payroll - Unless Payroll- elsewhere in this policy, do not modify any of the other otherwise indicated provisions of this policy. Class a) Flat Charge Per $100 Estimated ... | 1 |
COMMERCIAL AUTO SICA-1013 (0919) Starr Indemnity & Liability Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTENSION SCHEDULE OF NAMED INSUREDS AMENDATORY ENDORSEMENT Policy Number: 1000198668211 Effective Date: 6/1/2021 Named Insured: Burke Construction Group, Inc. This endorsement modifies th... | 2 |
event" will include "occurrences" resulting from: explosions and other man-made disasters; serious accidents resulting in multiple deaths, burns, dismemberment injuries; traumatic brain injuries; permanent paralysis injuries; or injuries from contamination of food, drink or pharmaceuticals. "Catastrophe management firm... | 2 |
7. "Bodily injury" to anyone using a vehicle without E. Changes In Conditions a reasonable belief that the person is entitled to The Conditions are changed for Auto Medical do so. Payments Coverage as follows: 8. "Bodily Injury" sustained by an "insured" while 1. The Transfer Of Rights Of Recovery Against "occupying" a... | 2 |
WC 04 03 01 D WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 02-18) It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endors... | 2 |
Starr Indemnity & Liability Company Starr Indemnity Commercial Auto Liability Program Claim Reporting Guidelines Please Send All Commercial Auto Liability Loss Notices To our Claims Administrator: Sedgwick Claims Management Services Sedgwick CMS P.O. Box 14155 Lexington, KY 40512-4155 Claims E-mail: 6260StarrCompanies@... | 2 |
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OKLAHOMA ELECTION OF COVERAGE NOTIFICATION ENDORSEMENT Policy Number: 37 WE BP6053 Endorsement Number: Effective Date: 01/01/14 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: TRG CUSTOMER SOLUTIONS INC... | 2 |
WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) F. Other Insurance 2. The amount you owe has been determined We will not pay more than our share of damages with our consent or by actual trial and final and costs covered by this insurance and other judgment. insurance or self-insur... | 2 |
Uninsured Motorist - Underinsured Motorist Liability Selection/Rejection of Coverage U-UMB-453 AMU 07 03 Welding Health Hazard Exclusion U-UMB-489 ACW 06 04 Sanctions Exclusion Endorsement U-GU-1191 ACW 03 15 Signed by: Authorized Representative Date U-UMB-104-A CW (7/99) Page 2 of 2 | 2 |
WORKERS COMPENSATION CLASSIFICATION SCHEDULE Insurance for this coverage part provided by: ZURICH AMERICAN INSURANCE COMPANY Policy Number WC 5393917-13 ITEM 4. CLASSIFICATION OF OPERATIONS PREMIUM BASIS RATES Entry in this item, except as specificallyprovided elsewhere in this Total Estimated Estimated LOC. policy, do... | 1 |
ITEM THREE Schedule Of Hired Or Borrowed Covered Auto Coverage And Premiums (Cont'd) Rental Period Rating Basis For Mobile Or Farm Equipment Estimated Number Of Days Equipment Will Be Rented Premium Town and State Where The Job Mobile Farm Coverages Site Is Located Equipment Equipment Mobile Equipment Farm Equipment Co... | 2 |
SCHEDULE OF UNDERLYING INSURANCE Issued to: ACCUTEST CORPORATION Policy Number: BE 015157724 By: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. TYPE OF POLICY INSURER, POLICY NO. OR COVERAGE AND POLICY PERIOD LIMITS GENERAL LIABILITY Zurich American $1,000,000 Insurance Company PER OCCURRENCE 07/01/14 $2,000,... | 2 |
Policy Number GLO 0144516-01 SCHEDULE OF FORMS AND ENDORSEMENTS Zurich American Insurance Company Named Insured EASTON DIAMOND SPORTS, LLC Effective Date: 02-27-18 12:01 A.M., Standard Time Agent Name LOCKTON COMPANIES LLC Agent No. 37385-000 COMMON & GENERAL LIABILITY FORMS AND ENDORSEMENTS U-GU-D-310-A 01-93 COMMON P... | 0 |
Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number UNION COUNTY CONSTRUCTION GROUP, INC. 638 CHERRY STREET Policy Number GLOUCESTER CITY NJ 08030 Symbol: RWC Number: C58582542 Policy Period Effective Date of Endorsement 04-29-2020 TO 12-01-2020 04-29-2020 Issued By (Name of Insurance... | 2 |
ANNUAL MEETING NOTICE Your policy includes a statement regarding membership rights in the Liberty Mutual Holding Company Inc. Liberty Mutual Fire Insurance Company is a Massachusetts stock insurance company subsidiary of the Liberty Mutual Holding Company Inc., a Massachusetts mutual holding company. Insurance is provi... | 2 |
CANCELLATION AMENDATORY ENDORSEMENT Named Insured Endorsement Number Dillard's Inc. 9 Policy Symbol Policy Number Policy Period Effective Date of Endorsement XOO G27373938 1/28/2014 - 1/28/2015 1/28/2014 Issued By (Name of Insurance Company) ACE Property and Casualty Insurance Company THIS ENDORSEMENT CHANGES THE POLIC... | 2 |
AIG NOTICE OF LOSS/NOTICE OF CLAIM INSTRUCTIONS: PLEASE ATTACH ALL CORRESPONDENCE RELATING TO THIS NOTICE OF LOSS AND MAIL COPIES OF THIS NOTICE TO THE ADDRESS BELOW: AIG Claims P.O. Box 305904 Nashville, TN 37230-5904 Fax: 866-260-0104 Email: SeverityFNOL@aig.com Date of Notice: NAMED INSURED: LAYFIELD USA CORPORATION... | 2 |
IL 02 45 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MINNESOTA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAG... | 2 |
With respect to this exclusion, Paragraph C.5. D. In the event of any incident of "terrorism" that is describes the threshold used to measure the not subject to the exclusion in Paragraph B. or C., magnitude of an incident of "terrorism" and the coverage does not apply to "any injury, damage, circumstances in which the... | 2 |
POLICY NUMBER: 37 C S38817 LISTING OF COVERAGE PARTS AND ENDORSEMENTS FORMING A PART OF THE POLICY The following is a listing of policy provisions, forms and endorsements by Form Number and Title that form a part of the policy at issue. FORM NUMBER TITLE 25 CG2026 04-13 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZ... | 0 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A Edition 1/08 EXTENSION OF INFORMATION PAGE Name and Address of Insured: Policy No: RWR9435384-02 Towne Holdings, Inc. 12350 Road 150 Policy Period: 01-01-2015 To 01-01-2016 Mayetta, KS 66509 NAICS#: 812930 FEIN: 770685277 # Of Employees: 85 Ins... | 1 |
POLICY NUMBER: 1000198668211 COMMERCIAL AUTO CA 20 70 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE FOR CERTAIN OPERATIONS IN CONNECTION WITH RAILROADS This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIERS ... | 2 |
EXTENSION OF THE INFORMATION PAGE - ITEM 3.D. - ENDORSEMENTS Policy Number: 46 WN OW3508 Endorsement Number: Effective Date: 12/12/2021 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: APM & ASSOCIATES , INC. 2201 MAIN ST STE 1100 DALLAS, TX 75201 Item 3. .D. of the... | 0 |
SECTION I PARTS ONE and TWO PART THREE 1. WE WILL ALSO PAY 2. How This Insurance Applies D. We Will Also Pay of Part One (WORKERS' Paragraph 4. of A. How This Insurance Applies COMPENSATION INSURANCE); and of Part 3 (Other States Insurance) is replaced by the following: E. We Will Also Pay of Part Two (EMPLOYERS' LIABI... | 2 |
10. From or as a consequence of the following If two or more policies have equal priority whether controlled or uncontrolled or however within the highest applicable number in the pri- caused: ority order: a. Nuclear reaction; 1. The insurer against whom the claim is first b. Radiation; or made shall process and pay th... | 2 |
ITEM TWO Schedule Of Coverages And Covered Autos This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of... | 2 |
THE HARTFORD Network Referral Unit What is a Workers' Compensation medical network? A medical network is simply an organization that has ready access to physicians, hospitals and other medical care providers who have experience treating Workers' Compensation related injuries. It also helps you manage the cost associate... | 2 |
COMMERCIAL AUTO CA 01 17 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WISCONSIN CHANGES For a covered "auto" licensed or principally garaged in, or "auto dealer operations" conducted in, Wisconsin, this endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSIN... | 2 |
COMMERCIAL AUTO CA 23 94 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SILICA OR SILICA-RELATED DUST EXCLUSION FOR COVERED AUTOS EXPOSURE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respe... | 2 |
E. Premiums If you die, your rights and duties will be transferred The first Named Insured shown in the Declarations: to your legal representative but only while acting within the scope of duties as your legal 1. Is responsible for the payment of all premiums; representative. Until your legal representative is and appo... | 2 |
ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of... | 2 |
Item 4. Premium - Extension of Information Page Claucification of Operations Premium Basic Rate Entries in this item, except as specifically provided Payroll - Unless Payroll- elsewhere in this policy, do not modity any of the other otherwise indicated provisions of this policy. Claud a) Flat Charge Per $100 Estimated ... | 1 |
SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY Company Code: 6 Policy Number: 37 WB BN3284 Schedule Number: 01-35-01 Effective Date: 10/01/13 Effective ho... | 1 |
Insurance AXA Regulatory Office 505 Eagleview Blvd., Suite 100 Dept: Regulatory Exton, PA 19341-1120 Telephone: 800-688-1840 COMMERCIAL LINES POLICY COMMON POLICY DECLARATIONS COMPANY PROVIDING COVERAGE: Greenwich Insurance Company POLICY NO.: RAD943796401 RENEWAL OF: RAD9437964 POLICY PERIOD FROM: April 1, 2020 TO: Ap... | 2 |
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. KANSAS CANCELLATION AND NONRENEWAL ENDORSEMENT Policy Number: 37 WEC BX4319 Endorsement Number: Effective Date: 05/03/16 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: RLC, LLC 5015 NW CANAL ST STE 100... | 2 |
SCHEDULE OF COVERED AUTOS YOU OWN (ITEM THREE OF THE DECLARATIONS) (Continued) POLICY NUMBER: 37 UEN KW8365 Absence, if any, of a limit entry below means that the limit entry shown in the corresponding ITEM TWO of the Declarations Limit Column applies instead. NO. 00038 10 TOYOT ID NO. JTDKN3DU5A0145528 GARAGED: LOUISV... | 2 |
Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number E.E. BISS HEATING & COOLING INC. 1144 MAPLE DRIVE Policy Number FREDERICKSBURG PA 17026 Symbol: RWC Number: C58581872 Policy Period Effective Date of Endorsement 04-17-2020 TO 12-01-2020 04-17-2020 Issued By (Name of Insurance Compan... | 2 |
The First Liberty Insurance Corporation Item 3. Coverage D - Extension of Information Page Miscellaneous Form and Endorsement Schedule Policy Notices and Applications Form Number Form Name SNW 42 03 05 20 Have a Workers' Compensation Complaint or Need Help? FORM 12-1 (CCPAP IL Construction Classification Premium Adjust... | 0 |
POLICY NUMBER: AS2-641-433446-140 COMMERCIAL AUTO CA 01 21 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED MEXICO COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to cov... | 2 |
Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number E.E. BISS HEATING & COOLING INC. 1144 MAPLE DRIVE Policy Number FREDERICKSBURG PA 17026 Symbol: RWC Number: C58581872 Policy Period Effective Date of Endorsement 04-17-2020 TO 12-01-2020 04-17-2020 Issued By (Name of Insurance Compan... | 2 |
UE United Educators payment of Claims, resolution of disputes, allocation of the proceeds of this Policy, the giving and receiving of notice of cancellation, the receiving of any return premiums that may become due and the giving of notice to entities or persons whom the Educational Organization chooses to not make an ... | 2 |
XS SU 3002 (12 07) HDI GLOBAL INSURANCE COMPANY SCHEDULE OF UNDERLYING INSURANCE PRIMARY INSURANCE POLICY # POLICY PERIOD RETRO DATE INSURER LIMITS GENERAL LIABILITY GLD13303-02 07/01/2017-2017 12/31/2008 HDI Global $2M/$1M AUTO LIABILITY 37UEN NJ 4000 12/31/2016-2017 12/31/2008 The Hartford $1M EMPLOYERS LIABILITY COW... | 2 |
NI EX 10 01 01 11 NATIONAL INTERSTATE NATIONAL INTERSTATE INSURANCE COMPANY 3250 INTERSTATE DR. RICHFIELD, OH 44286-9000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL EXCLUSIONS This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE PART The fo... | 2 |
Schedule Of Covered Autos You Own (Cont'd) Coverages - Premiums, Limits And Deductibles (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding Item Two column applies instead.) Coverages Limit Premium Covered Autos Liability $ 1,000,000 $ 784 Personal I... | 2 |
SAFETY NATIONAL CASUALTY CORP BUSINESS AUTO DECLARATIONS ST. LOUIS, MO 63146 Policy Number: CAS4054911 (888) 995-5300 Named Insured: MICHAELS STORES, INC. Agent: LOCKTON COMPANIES LLC Effective Date: 06/01/2017 Specified Causes of Loss $ Collision $ Towing and Labor $ Location No: (Check One) Gross Receipts (Per $100) ... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A Edition 1/08 EXTENSION OF INFORMATION PAGE Name and Address of Insured: Policy No: RWR9435384-02 Towne Holdings, Inc. 8303 Dodge Street Policy Period: 01-01-2015 To 01-01-2016 Omaha, NE 68114 NAICS#: 812930 FEIN: 770685277 # Of Employees: 87 In... | 1 |
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